The condition of fistulas has been known since ages, and different management techniques for it have been suggested in medical literature. However, it continues to be one of the most challenging clinical problems in anorectal surgery.
For 12 long years, US-based Julie Rogers suffered from a Grade 5 super complex fistula. Her personal health challenges made her seek a series of treatments that unfortunately did not offer long-term relief. She had no idea what to expect when she arrived in Pune in July, where Healing Hands Clinic and its team performed the Distal Laser Proximal Ligation (DSPL) procedure and freed her from pain.
There are various kinds of fistulas, and Healing Hands Clinic's patients vouch for a cent-per-cent cure. Take for instance Pune’s Dr. Saloni Joshi, who developed an obstetric fistula — a hole between the birth canal and bladder and/or rectum caused by prolonged obstructed labor — but was cured completely.
What is a Complex Fistula?
An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. “Fistula-in-ano is one of the most commonly encountered surgical problems with the prevalence of average 2/10,000,” says Healing Hands Clinic. The clinic specifically designed the Distal Laser Proximal Ligation procedure for highly complex anal fistulas.
Various surgical interventions have had variable success. The surgical management of complex fistulas is usually aimed at the permanent elimination of the suppurative process by drainage of sepsis and removal of fistula tracts while maintaining sphincter integrity.
Recently, the Indian Journal of Colo-Rectal Surgery concluded that minimally invasive, sphincter-saving DLPL surgery is safe and effective for complex fistula-in-ano. “This is a minimally invasive sphincter-saving surgery for complex fistulas. Basically, it addresses the intersphincteric space, which is the root cause of complex fistulas,” says Healing Hands Clinic, which has performed 4,661 such surgeries till date. In Julie’s case, an inflammatory bowel disease (Crohn’s disease) led to the fistula developing between one loop of intestine and another.
What is the DLPL Surgery?
The clinic explains that the DLPL is based on two principles. One is debridement, which is a procedure for treating the wound on the skin. Efficient debridement is one of the causes of recurrence in fistulas. This is achieved in a minimally invasive way by using a laser, which takes care of the fibrosis associated with complex fistulas. The debridement is thorough and deep with the use of a laser, which can be easily negotiated within the intersphincteric space and supralevator space.
“The other principle is the efficient drainage from the fistula in the first two to three weeks, which is the key to success in curing it after surgery,” they say.
DLPL is performed under the guidance of a 3D EndoAnal Imaging machine, which can identify hidden fistula tracts and micro abscesses in real-time during surgery. This is the key in getting assured results with surgery. It also minimizes the risk of damage to sphincter muscles.
Widening of the external opening serves that purpose while superficial incision over the internal opening helps in proper drainage in the initial three weeks after surgery. This is achieved by timely follow-up planned at five days, two weeks, four weeks, and six weeks. “That is the reason why DLPL is associated with a negligible recurrence rate,” Healing Hands Clinic says.
There is no need for daily dressing with DLPL, and the patient can resume work in about five days. There is also no risk of incontinence as sphincter muscles are not incised, says the clinic, which has trained over 250 surgeons in India and worldwide.
